Background: Varicella zoster virus (VZV) infection may provoke life-threatening cerebrovasculopathy. Diagnosis in immunocompromised patients is often complicated because of the possibility of multiple infections (1, 2). We present unique magnetic resonance angiographic images of VZV-associated cerebrovasculopathy in an immunocompromised patient.

Case Report: A 36-year-old homosexual man with HIV infection was hospitalized for evaluation of convulsions. He had a vesicular rash on the right knee, redness and itching sensations in the right eye (herpes zoster ophthalmicus), neck stiffness, and a temperature as high as 38 °C. Neurologic examination revealed memory loss and inability to perform simple arithmetic. The patient did not have ptosis, significant vision loss, or ocular cranial nerve palsies. Results of laboratory studies revealed a CD4 cell count of 0.036 × 109 cells/L and an HIV viral load of 39 000 copies/mL. Serum and cerebrospinal fluid levels of VZV-IgG were 6.4 IU/mL and 4.6 IU/mL, respectively, and polymerase chain reaction testing detected VZV-DNA in the cerebrospinal fluid. A diagnosis of VZV encephalomeningitis was made. Immediate treatment with intravenous acyclovir (30 mg/kg of body weight daily) was begun.